Exhibit O
Subscriber Counts/Location, Prior Claims History and Utilization Facts
The following pages contain history of claims, subscriber and member counts, information about where State members are located, and general, selected utilization information.
- Overall claims paid from 10/1/02 through 9/30/04. While claims are provided to vendors in the manner, the vendor who is awarded the contract must report such information to the State monthly in the categories of:
- State Standard Plan excluding graduate assistants
- State Standard Plan graduate assistants only
- State SMP excluding graduate assistants
- State SMP graduate assistants only
- Medicare Plus $1,000,000
- Local Standard Plan (4 versions)
- Classic
- Deductible
- PPP
- Deductible PPP
- Local SMP (2 versions)
- Local Annuitants (4 versions)
- Classic
- Deductible
- PPP
- Deductible PPP
- Overall contracts from 10/1/02 through 9/30/04. The successful vendor will be required to report this data to the State in the same divisions as claims.
- Overall members from 10/1/02 through 9/30/04. The successful vendor will be required to report this data to the State in the same divisions as claims.
- State members by county in Wisconsin (Separate tabs for 2, 12 month periods.)
- State members by state outside of Wisconsin
- State members by zip code
- Utilization Data:
- State of Wisconsin Medicare and Non-Medicare PAYMENT SUMMARY Incurred 1/1/03 through 12/31/03. This document includes all State of Wisconsin members, employees and annuitants. It does not include Local members.
- State of Wisconsin - Employees TOTAL PAYMENTS BY DISEASE CATEGORY. For the period 1/1/03 through 12/31/03, for State of Wisconsin non-Medicare members. It includes early retirees under 65. It does not include major medical services. It does not include Local members.
- State of Wisconsin - Employees SUMMARY OF MOST FREQUENTLY UTILIZED INPATIENT FACILITIES. For the period 1/1/03 through 12/31/03, for State of Wisconsin non-Medicare members. It includes early retirees under 65. It does not include Local members.
- State of Wisconsin - Public Employees Medicare and Non-Medicare PAYMENT SUMMARY Incurred 1/1/03 through 12/31/03. This document includes all Local members, employees and annuitants. It does not include State members.
- State of Wisconsin - Public Employees TOTAL PAYMENTS BY DISEASE CATEGORY. For the period 1/1/03 through 12/31/03, for Local non-Medicare members. It includes early retirees under 65. It does not include major medical services. It does not include State members.
- State of Wisconsin - Public Employees SUMMARY OF MOST FREQUENTLY UTILIZED INPATIENT FACILITIES. For the period 1/1/03 through 12/31/03, for Local non-Medicare members. It includes early retirees under 65. It does not include State members.
- State of Wisconsin PAYMENT SUMMARY Incurred 1/1/04 through 5/31/04. This document includes all State of Wisconsin members, employees and annuitants. It does not include Local members.
- State of Wisconsin -TOTAL PAYMENTS BY DISEASE CATEGORY. For the period 1/1/04 through 5/31/04, for State of Wisconsin non-Medicare members. It includes early retirees under 65. It does not include major medical services. It does not include Local members.
- State of Wisconsin - Employees SUMMARY OF MOST FREQUENTLY UTILIZED INPATIENT FACILITIES. For the period 1/1/04 through 5/31/04, for State of Wisconsin non-Medicare members. It includes early retirees under 65. It does not include Local members.
- Out of State subscribers by zip code. Also lists out-of-country subscribers.
- Census for group relevant to RFP. This includes LAHP subscribers.
- LAHP Experience.
- Local Experience for Stop Loss